Cardiovascular Emergencies. …time is myocardium!. Statistics. Cardiovascular disease (CVD) claimed over 1 million lives in 2004. CVD has been the leading cause of death for Americans since 1900. Sudden cardiac death accounts for over 40% of these deaths.
…time is myocardium!
High blood pressure
Elevated cholesterol levels
Elevated blood glucose levels
Lack of exercise
…you are dispatched to a 67 year- old male c/o 9/10 “crushing” chest pressure that radiates to his jaw. He is also complaining of shortness of breath and nausea, with no previous cardiac history…
N Engl J Med 1984;311:1144-7
Used to describe the range of conditions from unstable angina to AMI.
Signs and symptoms usually caused by acute myocardial ischemia.
Usually caused by the same mechanism as angina only with resulting tissue death.
Time is myocardium:
Consequences can be serious:
Congestive heart failure
Heart lacks power to force blood through the circulatory system.
Brought on when 40% of left ventricle is infarcted.
Onset may be immediate or not apparent for 24 hours.
Occurs when the ventricles are damaged.
Heart tries to compensate with increased heart rate.
Enlarged, ineffective left ventricle
Fluid builds up into lungs or body as “pump” fails.
Initial Assessment (Sick/Not Sick)
Treatment and Plan
Your subjective findings are based upon what the patient or historian tells you:
N Eng Journal Med 1984;311:11444-7
“When and at what time did it start”
“Does anything make it better or worse?”
“Does it change with position, palpitation, inspiration?”
“Describe the pain/discomfort in your own words”
“Where does it start?”
“Does it radiate anywhere?”
“On a scale of 1 to 10, what was the pain/discomfort at onset?”
“What is the pain/discomfort at now?’
“When did this episode start?”
“How long has it been going on?”
Cardiac meds = cardiac problems.
Ask about OTC meds, natural supplements, vitamins?
“Do you have any cardiac history?”
“Risk factors such as smoking, diabetes, HTN, weight/diet?””
“What were you doing when this event started?”
Think activity induce vs. non activity
…they will tell you exactly what is wrong!
Objective findings from your physical exam of the patient.
This is your best guess (or rule out) as to what is going on with the patient.
It is based upon YOUR Subjective and Objective findings and should help you develop and implement your Plan for patient care.
Patient in position of comfort.
Oxygen via ?
Assist with medications.
Maintain body temperature.
Calm and reassure.
Minimize patient movement.